Child and Adolescent BH Residential Coordinator

Job DescriptionBusiness OverviewAs part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.This is a fulltime remote worker opportunity in Ohio. This position is designed to support OhioRISE members seeking treatment at Psychiatric Residential Treatment Facilities (PRTFs). Qualified candidates must reside in Ohio.Fundamental Components: Appropriately matching members approved for PRTF level of care to PRTF programs that can meet their treatment needs in a culturally informed manner. Coordinating referrals to PRTF providers. Facilitating communication and information exchange among the PRTF providers, the members' CFT (including outpatient providers and child-serving agencies), and other internal OhioRISE teams including care coordination, provider relations, utilization management, and Transition of Care (TOC). Following-up with the PRTFs on their decisions regarding acceptance or denial of referred members and tracking decision rationales. Communicating the PRTF responses to the member's CFT. Maintaining accurate lists of in-network PRTF providers and their areas of clinical specialty, ages/genders and special populations served. Outreaching additional PRTF providers when in-network providers are not available/able to meet member's treatment needs. Working with Provider Relations team to facilitate PRTF providers becoming registered with Ohio Department of Medicaid (ODM). Ensuring necessary documentation for admission is in place such as Change of Physical Custody (CPC), Interstate Compact on the Placement of Children (ICPC) and guardian consents. Escalating complex situations by staffing internally with UM Director and Medical Director. Documenting all activities in MedCompass. Maintaining data on referrals, acceptances, and denials in individual and aggregate formats. Acting as centralized point for information regarding PRTFs, CFTs, outpatient clinical teams, internal departments and other stake holders. Assisting with outreach to provider, managed care, and child-serving agencies to obtain needed clinical information to facilitate PRTF medical necessity determinations. Confirming OhioRISE eligibility. Providing technical assistance to internal and external stakeholders (including ODM) regarding matters concerning PRTF treatment for OhioRISE members.Pay RangeThe typical pay range for this role is:Minimum: 19.50Maximum: 38.99Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications Must reside in Ohio. Minimum two (2) years' practical experience working with children, adolescents, and/or young adults with behavioral health needs. Willing and able to travel in-state, 10-15% of the time. Ability to work core business hours, Monday-Friday, 8am-5pm, and flexibility to work outside of core hours when required, to meet the needs of our members. 2 + years of experience working with personal computer, keyboard navigation and MS Office Suite applications including, Teams, Outlook, Word, and Excel.Preferred Qualifications Working knowledge of System of Care principles and of Ohio child-serving agencies preferred. Familiarity with High Fidelity Wraparound and Child and Family Teams (CFT) is preferred.Education Bachelor's degree in a behavioral health or related field is required.Business OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15